* NOTE:  It should be noted that the emergency modifier and the after hours emergency modifiers cannot both be claimed in the one anaesthesia assistance at anaesthesia or perfusion episode.

ASA physical status indicator 3 - A patient with severe systemic disease that significantly limits activity (item 25000). This would include: severely limiting heart disease; severe diabetes with vascular complications or moderate to severe degrees of pulmonary insufficiency.

As far as left-handed or right-handed coordinate systems, with all the popular 3D software out there ranging from like Unreal Engine to Unity to Marmoset to Maya to 3DS Max to XSI to Blender, it's rather split in my experience with no strong signs of convergence. I think right-handed might be ever so-slightly common in what I've encountered (in terms of world space), but not to the point where I'd even declare it de-facto standard.

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For the purposes of the after hours emergency modifier items, the after hours period is defined as being the period from 8pm to 8am on any weekday or at any time on a Saturday, a Sunday or a public holiday. Benefit for the After Hours Emergency Modifiers is only payable where more than 50% of the time for the emergency anaesthesia, the assistance at emergency anaesthesia or the perfusion service is provided in the after hours period. In situations where less than the 50% of the time for the service falls in the after hours period, the emergency modifier rather than the after hours emergency modifier applies. For information about deriving the fee for the service where the after hours emergency modifier applies.

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However, on a few occasions I absent-mindedly reverted to the convention I'd become more accustomed to programming, mostly in 2d without any z at all,

Needless to say, lots of time wasted debugging until I realized what the problem actually was. And then (which is now), I tried googling stuff like https://www.cs.uic.edu/~jbell/CourseNotes/ComputerGraphics/Coordinates.html to determine some "industry standard" convention, and particularly some >>rationale<< behind it that won't slip my mind while coding. So that page seems to suggest the z-axis-out-of-screen (bottom drawing) convention. But I'm not googling any actual standard about it. Is there such a thing, hopefully along with some reasoning why one's better than the other?

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For up to and including the first - 2 hours of time, each 15 minutes (or part thereof) constitutes 1 time unit. For time beyond 2 hours, each time unit equates to 10 minutes (or part thereof).

The reason for using either a left handed co-ordinate system or a right handed co-ordinate system may be historical, cultural, technical or arbitrary. X to the right and Y up is pretty standard though in 3D graphics land.

A small sample of my own little notes and "visual babystepping" (I have hundreds of these), and if I'm working from a paper I actually try to match their own diagrams of the intermediate steps of the algorithm to verify that I'm implementing it correctly so far. I have little functions like db_line (draw a debugging line into viewport) along with similar functions to draw labels and points and axes and planes and matrix coordinate systems and such.

Related Items: 23010 23025 23035 23045 23055 23065 23075 23085 23091 23101 23111 23112 23113 23114 23115 23116 23117 23118 23119 23121 23170 23180 23190 23200 23210 23220 23230 23240 23250 23260 23270 23280 23290 23300 23310 23320 23330 23340 23350 23360 23370 23380 23390 23400 23410 23420 23430 23440 23450 23460 23470 23480 23490 23500 23510 23520 23530 23540 23550 23560 23570 23580 23590 23600 23610 23620 23630 23640 23650 23660 23670 23680 23690 23700 23710 23720 23730 23740 23750 23760 23770 23780 23790 23800 23810 23820 23830 23840 23850 23860 23870 23880 23890 23900 23910 23920 23930 23940 23950 23960 23970 23980 23990 24100 24101 24102 24103 24104 24105 24106 24107 24108 24109 24110 24111 24112 24113 24114 24115 24116 24117 24118 24119 24120 24121 24122 24123 24124 24125 24126 24127 24128 24129 24130 24131 24132 24133 24134 24135 24136

I came across this problem once I started implementing different renderers for various 3d model formats. In my head, x was pointing right, y up and z out of the screen. Then I noticed that the models were off. Thats how I learnt about it!

If you come from drawing on paper laying flat on a desk, you will likely consider x to the right, y away from you and z up.

In the old days when we had CRT screens it could make a difference which parts of the screen were rendered first. The picture on the screen would be build from top to bottom and from left to right. If you had a frame buffer, lower memory locations would map to higher and lefter screen pixels. The direction in which you rendered could cause or prevent flicker.

NOTE: It should be noted that the Medicare Benefits Schedule does NOT include modifying units for patients assessed as ASA physical status indicator 2. Some examples of ASA 2 would include:

For this type of thing, and as one who isn't the type to debug code and start drawing out mathematical notes and diagrams on drawing boards figuring out where I went wrong (I envy people who have the patience and mindset to do this, however), I found it very helpful to have like a "visual debug" library where I can temporarily draw lines and planes and axes and so forth (like old school debugging with printf output to figure out where we went wrong, only with visual outputs to the viewport). It requires some patience of its own as well, but I find it immensely useful in these cases. I've often found with algorithms heavy on the linear algebra that crawling is faster than running and falling into a ditch, to test every single function's visual output for correctness as we're trying to implement something complex. It's like "visual TDD", since I'm often lacking in the smarts to verify correctness in elaborate mathematical ways in these cases short of just seeing if it gives the correct visual output.

When it comes to Y/Z in world space, it is more common in my experience to see Y pointing up/down (vertical) and Z pointing in/out (depth). I suspect the mindset there is to label the world in terms of the initial viewing plane in front view. Yet there are some big dogs like 3DS Max who use Z for vertical, perhaps with the mindset of thinking of world space axis labeling in terms of the ground plane.

As per clause 5.9.5 of Schedule 1 of the GMST, all RVG items 23010 to 24136 apply to a service provided to a patient under anaesthesia, but only if the anaesthesia start and end times are recorded in writing. Basic Units The RVG basic unit allocation represents the complexity of the anaesthetic procedure relative to the anatomical site and physiological impact of the surgery.  Time Units The number of time units is calculated from the total time of the anaesthesia service, the assistant at anaesthesia service or the whole body perfusion service: for anaesthesia, time is considered to begin when the anaesthetist commences exclusive and continuous care of the patient for anaesthesia. Time ends when the anaesthetist is no longer in professional attendance, that is, when the patient is safely placed under the supervision of other personnel; for assistance at anaesthesia, time is taken to be the period that the assistant anaesthetist is in active attendance on the patient during anaesthesia; and for perfusion, perfusion time begins with the commencement of anaesthesia and finishes with the closure of the chest. For up to and including the first - 2 hours of time, each 15 minutes (or part thereof) constitutes 1 time unit. For time beyond 2 hours, each time unit equates to 10 minutes (or part thereof). Modifying Units (25000 - 25050) Modifying units have been included in the RVG to recognise added complexities in anaesthesia or perfusion, associated with the patient's age, physical status or the requirement for emergency surgery. These cover the following clinical situations: ASA physical status indicator 3 - A patient with severe systemic disease that significantly limits activity (item 25000). This would include: severely limiting heart disease; severe diabetes with vascular complications or moderate to severe degrees of pulmonary insufficiency. Some examples of clinical situations to which ASA 3 would apply are: a patient with ischaemic heart disease such that they encounter angina frequently on exertion thus significantly limiting activities; a patient with chronic airflow limitation who gets short of breath such that the patient cannot complete one flight of stairs without pausing; a patient who has suffered a stroke and is left with a residual neurological deficit to the extent that is significantly limits normal activity, such as hemiparesis; or a patient who has renal failure requiring regular dialysis. ASA physical status indicator 4 - A patient with severe systemic disease which is a constant threat to life (item 25005). This covers patients with severe systemic disorders that are already life-threatening, not always correctable by an operation. This would include: patients with heart disease showing marked signs of cardiac failure; persistent angina or advanced degrees of pulmonary, hepatic, renal or endocrine insufficiency. ASA physical status indicator 4 would be characterised by the following clinical examples: a person with coronary disease such that they get angina daily on minimum exertion thus severely curtailing their normal activities; a person with end stage emphysema who is breathless on minimum exertion such as brushing their hair or walking less than 20 metres; or a person with severe diabetes which affects multiple organ systems where they may have one or more of the following examples: severe visual impairment or significant peripheral vascular disease such that they may get intermittent claudication on walking less than 20 metres; or severe coronary artery disease such that they suffer from cardiac failure and/or angina whereby they are limited to minimal activity. ASA physical status indicator 5 - a moribund patient who is not expected to survive for 24 hours with or without the operation (item 25010). This would include: a burst abdominal aneurysm with profound shock; major cerebral trauma with rapidly increasing intracranial pressure or massive pulmonary embolus. The following are some examples that would equate to ASA physical status indicator 5 a burst abdominal aneurysm with profound shock; major cerebral trauma with increasing intracranial pressure; or massive pulmonary embolus. NOTE: It should be noted that the Medicare Benefits Schedule does NOT include modifying units for patients assessed as ASA physical status indicator 2. Some examples of ASA 2 would include: A patient with controlled hypertension which has no affect on the patient's normal lifestyle; A patient with coronary artery disease that results in angina occurring on substantial exertion but not limiting normal activity; or A patient with insulin dependant diabetes which is well controlled and has minimal effect on normal lifestyle. Where the patient is aged under 4 years old (item 25013) or at least 75 years (item 25014). For anaesthesia, assistance at anaesthesia or a perfusion service in association with an *emergency procedure (item 25020).  For anaesthesia or assistance at anaesthesia in association with an *after hours emergency procedure (items 25025 and 25030). For a perfusion service in association with *after hours emergency surgery (item 25050). * NOTE:  It should be noted that the emergency modifier and the after hours emergency modifiers cannot both be claimed in the one anaesthesia assistance at anaesthesia or perfusion episode. It should also be noted that modifiers are not stand alone services and can only be claimed in association with anaesthesia, assistance at anaesthesia or with a perfusion service covered by item 22060.  Definition of Emergency For the purposes of both the emergency modifier and the after hours emergency modifiers, emergency is defined as existing where the patient requires immediate treatment without which there would be significant threat to life or body part.  Definition of After Hours For the purposes of the after hours emergency modifier items, the after hours period is defined as being the period from 8pm to 8am on any weekday or at any time on a Saturday, a Sunday or a public holiday. Benefit for the After Hours Emergency Modifiers is only payable where more than 50% of the time for the emergency anaesthesia, the assistance at emergency anaesthesia or the perfusion service is provided in the after hours period. In situations where less than the 50% of the time for the service falls in the after hours period, the emergency modifier rather than the after hours emergency modifier applies. For information about deriving the fee for the service where the after hours emergency modifier applies.

Also getting a bit fancy but I tend to prototype these things in script and made it so I can trace through the script line by line and plot what it's doing, one step-at-a-time, into a "debug watch viewport" where I can pan and rotate and zoom around while the script is at a breakpoint to visually examine results as well as plot new things while the script is halted. That might seem a bit overengineered but it was only through building and leaning on tools like this that I was ever able to keep up with the mathematical wizards in my industry. Otherwise I'm the type where if I'm asked to implement an IK solver on a motion hierarchy, I might get the initial implementation 99% correct on the first day only to spend the remainder of the entire week trying to figure out the 1% place where I went wrong in hindsight; with this I can catch those mistakes as I'm making them usually and save so much time.

Its been a few years since I implemented my software renderer but I still remember that there is no standard. X is usually fixed and y/z are random. That is why for some model importers the coordinates need to be adjusted to the format you are using!

ASA physical status indicator 4 - A patient with severe systemic disease which is a constant threat to life (item 25005). This covers patients with severe systemic disorders that are already life-threatening, not always correctable by an operation. This would include: patients with heart disease showing marked signs of cardiac failure; persistent angina or advanced degrees of pulmonary, hepatic, renal or endocrine insufficiency.

When I recently started doing some 3d graphics, I carefully (tried to be careful, anyway) decided to use the conventional mathematical standard for labelling axes, which was much more convenient for "doing the math" in this pretty math-heavy problem domain. And to try to avoid any confusion, I even included an ascii comment block drawing in the code, something like this

Its been years, perhaps the 3d scene has come to an agreement / standard on this issue, I dont know. I can imagine one reason for this mess though: Convention vs optimization. Convenation as in, people might be used to x-right, y-up, z-out whereas optimization forces people to use it the other way around, x, z, y because the assembler opcodes that parallelise vec4 calculations (names escaping me right now) might have their implementation focus on the x, z, y order because it might lead to less remapping for specific formulae required in the 3d domain! Might be completely off though, I am just guessing here. Sadly, cant imagine why else!

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Working in VFX, I'd echo the conclusion that there isn't really a standard. It's all over the place with the various software out there. I'd say you're doing all right if you can at least establish your own and stick to it.

Modifying units have been included in the RVG to recognise added complexities in anaesthesia or perfusion, associated with the patient's age, physical status or the requirement for emergency surgery. These cover the following clinical situations:

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The number of time units is calculated from the total time of the anaesthesia service, the assistant at anaesthesia service or the whole body perfusion service:

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It should also be noted that modifiers are not stand alone services and can only be claimed in association with anaesthesia, assistance at anaesthesia or with a perfusion service covered by item 22060.

The RVG basic unit allocation represents the complexity of the anaesthetic procedure relative to the anatomical site and physiological impact of the surgery.

As per clause 5.9.5 of Schedule 1 of the GMST, all RVG items 23010 to 24136 apply to a service provided to a patient under anaesthesia, but only if the anaesthesia start and end times are recorded in writing.

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It's like if I'm trying to test out a complex transformation involving multiple coordinate systems and paths and objects, then I can write a proper automate unit test verifying that the object ends up in the correct place after that series of transformations. But if something goes wrong in the implementation of whatever interface I'm testing and the test fails, I just lack the smarts to debug it without visualizing what's going on. So for me at least, it's so helpful to develop these algorithms in tiny little babysteps where we visually output the result of each little function we write for correctness.

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For the purposes of both the emergency modifier and the after hours emergency modifiers, emergency is defined as existing where the patient requires immediate treatment without which there would be significant threat to life or body part.

ASA physical status indicator 5 - a moribund patient who is not expected to survive for 24 hours with or without the operation (item 25010). This would include: a burst abdominal aneurysm with profound shock; major cerebral trauma with rapidly increasing intracranial pressure or massive pulmonary embolus.

23200 23200 - Additional Information Item Start Date: 01-Nov-2001 Description Updated: 01-May-2001 Schedule Fee Updated: 01-Jul-2024

To me the right hand rule is hardly helpful and just adds to the confusion. Just remember when people speak of left handed the Z axis goes into the screen and with right handed it comes out of the screen.

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Otherwise if something went wrong, I'd find myself staring at a boatload of numbers in the debugger that look like gibberish to me unless I actually start manually plotting things like points and lines and such on the drawing board, at which point it becomes a lot simpler to just let the computer do that for me and see where I went wrong. So this second part of the answer is not as directly related to your immediate question relating to standards, but I figure it might help for what you're trying to avoid which is spending ages trying to figure out where you went wrong (which is something I find all too common in this domain if we don't kind of test each little teeny step individually).